Relationships between several markers of extracellular matrix turn-over and ultrasonography in human Schistosomiasis mansoni.

Abstract

Abstract. We measured the concentrations of several serum and urinary fibrosis markers, which are metabolites of extracellular matrix, in schistosomiasis patients to investigate their relationship with the ultrasonographic scoring system and with parasitologic data. This study was conducted in patients with various stages of the disease evaluated by ultrasonography (intestinal disease with no organ involvement, with minor hepatosplenic involvement and with severe disease) and in endemic controls. The level of hyaluronan, which were increased in infected patients compared with controls (P Ͻ 0.01), was the only fibrosis marker that correlated with the ultrasonographic score (P ϭ 0.003) and is thus a potential serum marker of schistosomiasis-associated morbidity. Urinary free pyridinoline levels were lower (P Ͻ 0.001) in infected patients with fibrosis (score Ն 1) than in nonfibrotic patients. A two-year follow-up of the patients treated with praziquantel showed that type I collagen and hyaluronan decreased during the first year posttreatment, whereas free pyridinolines peaked after 12 months and decreased thereafter.With more than 200 million people affected worldwide and probably 500,000 deaths per year, schistosomiasis is the second major parasitic disease after malaria. 1-3 Five species of digenic trematodes affect humans, with Schistosoma mansoni, S. japonicum, and S. haematobium being the most important from an epidemiologic point of view. Progress towards the control of schistosomiasis has been recently made, but the development of appropriate tools is still required for the assessment of worm burden and of specific morbidity during the monitoring of the effects of chemotherapy and/or vaccination. [4][5][6] The recent application of ultrasonography in field conditions, including the Malagasy focus on which the present work is based, allowed the determination of a score that reflects S. mansoni-induced morbidity. 7,8 The ultrasonographic scoring of schistosome-induced hepatic injury, including periportal pipe-stem fibrosis, correlates well with the pathologic evidence of fibrosis in liver biopsies and to a lesser degree with the intensity of infection. 7,9 Although ultrasonography is a noninvasive technique, it is based on sophisticated tools, requires well-trained physicians, and its standardization is still a matter of debate after two World Health Organization (WHO)-sponsored workshops (Cairo, Egypt in 1990 and Niamey, Niger in 1996). More easy-touse indicators of morbidity, such as the reagent strip test for hematuria in S. haematobium infection, are clearly needed to monitor S. mansoni and S. japonicum infections and their reversal after chemotherapy. 10 This is particularly true for the planning and monitoring of control programs in areas of different endemicity, where public health decisions have to be made by existing basic health care services. 10 Several markers reflecting the turn-over of extracellular matrix (ECM), have been reported for the monitoring of fibrosis in a noninvasive way. 11,12 In t...

Soluble cellular adhesion molecules, selectins, VEGF and endothelin‐1 in patients with Wuchereria bancrofti infection and association with clinical status

“…These studies should help the development of low‐cost screens (presently based on VEGF, ET‐1 and CD62L serum levels and perhaps, in a near future, VEGF‐R3 and VEGF‐C/D molecules) to assess an individual's potential risk of developing the chronic forms of this parasitic disease. Whether it will be possible to combine these potential predictive morbidity markers and more lymphatic specific tools for continuous therapeutic evaluation, as recently proposed for visceral leishmaniasis (41) and schistosomiasis (26,42), is an important question that deserves future research.…”

Molecular and tissue alterations of collagens in fibrosis

“…Pyridinoline is excreted in urine upon degradation of mature collagen. In Schistosoma mansoniinfected patients pyridinoline is excreted in lower amount in the urine of patients with fibrosis than in infected patients without fibrosis [170]. The urinary level of pyridinoline is positively correlated to the collagen content of granulomas in Schistosoma mansoni-infected mice and negatively correlated to the length of the treatment follow-up in infected mice treated by an antiparasitic drug [171].…”

Two-year impact of praziquantel treatment for Schistosoma japonicum infection in China: re-infection, subclinical disease and fibrosis marker measurements

“…Decreases in the thickness of portal vein walls and in echogenic bands have been detected after praziquantel therapy (HOMEIDA et al, 1988;DOEHRING-SCHWERDTFEGER et al, 1989: OH-MAE et al, 1992WIEST et al, 1993;CAI>~ al., i997;GERSPACHER-LARA et aI, 1997;BOISIER et al, 1998). Assay of serum levels of fibrosis markers may be a useful supplementary tool for monitoring changes in liver fibrosis (SHAHIN et aZ., 1992;KARDORFF et al, 1997;OBERTI et al, 1997;ESTERRE et al, 1998;RICARD-BLUM et al, 1999).…”